Congenital Anomalies of the Uterus: septum

Congenital Anomalies of the Uterus: septum: A uterine septum is a vertical separation in the middle of the uterus dividing the cavity into two: right and left. The septum may be partial or could extend all the way through the cervix or even to a varying distance into the vagina.

Uterine Septum and congenital uterine anomalies

Many of these separations are unnoticed. Septa may be discovered accidentally e.g during a hysterosalpingogram (HSG) done to investigate infertility. The role of a reproductive endocrinologist is to a. confirm the diagnosis of a septum and differentiate it from other conditions that make the uterus appear as double; bicornuate uterus and uterus didelphys and b. to counsel the couple about the possible effects of the septum on reproduction and indication for corrective surgery of the uterus

Diagnosis of Uterine Spetum

After clinical exam to inspect the cervix, HSG can visualize the duplication of the uterus but cannot accurately differentiate a septum from two separate uterine horns. MRI and 3D ultrasound can accurately characterize the abnormality.

Effects of Uterine Septum on Reproduction

A septum is not a proven cause for infertility. In fact the majority of women with uterine septum are without symptoms. Some women with a septum manifest with recurrent first trimester pregnancy loss or less commonly late (second trimester) pregnancy loss and preterm labor.

It is unpredictable who will carry a pregnancy to term and who will have a pregnancy loss. Because the outcome cannot be predicted, the majority of reproductive endocrinologists

recommend resection of the septum to unify the uterine cavity. This is especially the case after this

Hysteroscopic Resection of Uterine Septum Completed

surgery can be accomplished with minimal access hysteroscopic surgery. An operative hysteroscope is introduced into the uterus and a micro scissors or an electric loop is used to cut the septum.

There is some evidence that resection of a septum may reduce the chance for pregnancy loss.

Accurate diagnosis of uterine septum is essential before discussing the possible reproductive consequences and method of correction.

Dr. Amr Azim

Amr Azim, MD, FACOG is a reproductive endocrinologist and a fertility specialist with special training in treating simple and complex fertility problems. His areas of expertise are assisted reproduction and preservation of fertility